Etiology and diagnosis of cerebral infarcts after the neonatal period

QUESTION: After the neonatal period, cerebral infarctions are very rare in childhood. In the present study we aim to evaluate the etiology and diagnostic procedures of this disorder on the basis of our own experience. METHODS: We saw four children aged 3 2/12 to 11 4/12 years with a cerebral infarction at our hospital. Three children were followed up until 6 months after the infarction. The case reports are presented. On the background of the literature, the etiology and diagnostic possibilities and requirements are discussed. RESULTS: As the underlying cause, we saw a hemolytic-uremic syndrome in one case, and a (post-)infectious vasculitis following measles resp. scarlet fever in two cases. CCT, NMR, and transcranial Doppler sonography are the diagnostic methods of choice, although none of these by itself is able to diagnose this disorder with any certainty. Therapeutic measures are restricted to the causative disease. The prognosis is good quoad vitam, although serious regarding neurologic sequelae. CONCLUSIONS: An early diagnosis of this disorder is essential, because the only known effective therapy is the management of a possibly underlying disorder. Intensive physiotherapy as an additional measure is helpful to avoid neurological sequelae.